In this final step
of the toolkit, we will close the loop of continuous quality improvement
by re-evaluating the status of your emergency department and circling back
to amend or continue the path to a safer emergency department, defined by
your original project plan. By re-evaluating your department after your
action plan has been implemented, you can gain knowledge regarding the validity
of your timeline and whether the action items are sufficient to meet the
outcomes as planned. You may find that outcomes have been met and it is
time to define new outcomes and action items as you move on to implement
more positive changes.

Evaluation of your
department for improvement after safety interventions is a critical part
of any quality improvement process in that it validates that you are on
the right path. While we invest hours of time and critical thinking in our
original plan, we must always be prepared to alter our plan should we discover
that the road to completion was not as we expected. How many of us can recall
a project that went completely as planned? By re-evaluating and adjusting
our project plan, we keep the workplace violence initiative relevant to
the goals we would like to see achieved and allow ourselves to have a greater
impact on change. To effectively adjust our project plan, we need to take
periodic "snapshots" of where we are in our workplace violence
initiative. It will help us define what is working, improving, not working
and what we need to do better.

Timing is key to
the re-evaluation of your department. At the outset of your project plan,
determine what a reasonable time frame would be for re-evaluation with the
assessment tools used in Step Two (Emergency Department Assessment Tool,
Staff Assessment Survey). You may find that there are designated re-evaluation
time frames necessitated by accreditation standards. You may find that there
are elements of your project plan, certain outcomes or action items, that
require a focused re-evaluation to gauge progress. The assessment tools
that have been provided in this ENA toolkit are designed to allow a focused
assessment of areas that are specifically impacted by your project plan
(such as the environment or staff perceptions). You may have had occurrences
since the beginning of the workplace violence initiative that have exposed
new priorities in terms of safety.

Here are some tips
for conducting your re-evaluation:

Use the same tools for re-evaluation
as for your initial assessment so you are comparing similar data;
if you introduce new assessment
tools be sure to use the first data collection as a baseline in which
to compare other data collected during re-evaluation.

As part of the re-evaluation,
get feedback from your workplace violence team; what do they feel has
worked, has the team dynamic been effective and what are the barriers
they have encountered. All of these observations may have an impact
on how you define your project plan going forward.

Don't forget to use the
occurrence reports as a source of re-evaluation information; when reviewing
reports, use those that have been documented since the last assessment
took place so there is no overlap.

Document all assessments
and summarize changes that are apparent based on the results.

Documentation

Documentation
of your re-evaluation findings is a critical step because this information
can be shared with a variety of audiences that are key to the success of
your workplace violence initiative. Share the summary information you collect
with these groups:

Workplace
Violence Team:
This is the group that likely has the most time and initiative invested
in the process of developing a plan to mitigate workplace violence.
The documentation of the re-evaluation will help this group define the
direction they will take with the original plan they devised and look
towards ongoing and future goals.

Administration:
Because this is a continuous quality improvement effort, the documentation
of interim evaluation of progress is important to show evidence of the
quality improvement effort to institutional accrediting and licensing
authorities. If there is a Quality Assurance or Continuous Quality Improvement
committee within your institution, consult with them to find the best
way for you to report your findings so that they are useful to administration.
Additionally, management within the insitution will need to see evidence
that the workplace violence project is a productive use of resources.
Documentation of findings and connecting the re-evaluation to the project
plans as you have developed them will demonstrate to management that
this is a valuable project and a wise use of time, skill and money.

Staff:
A common
pitfall when working through a project is to report results to supervising
personnel or adminstrators that approve the project and forgetting to
demonstrate and communicate progress to those that the outcomes will
affect the most. Sharing your findings with the emergency department
staff, that is, documenting progress through a re-evaluation and demonstrating
that you are will to take information acquired through this process
and make adjustments to achieve a bigger safety impact, will go far
in gaining the trust from the staff members in the emergency department,
both for the project and the changes implemented and in the leaders
of the project.

The following is
a list of toolkit resources and references used in Step Two: Analyze your
Emergency Department's Present Status:

In completing this
step, we emphasized the importance of using similar tools for both evaluation
and re-evaluation so you are comparing similar data and can begin to draw
some conclusions about the progress that has been made. You should have
all the elements necessary to measure and document the progress you have
made towards achieving the outcomes you have stated in Step Two of this
process. More importantly, completion of this step represents the achievement
of one cycle of this quality improvement inititative. From understanding
the issue, assessing the current situation, defining where you want to be
(outcomes) and how to get there (action plan), this final step evaluates
the impact of the choices you have made so far and gives you the ability
to make adjustments in your plan. From this point, the cycle continues until
you re-evaluate again and measure progress and either complete parts of
your plan and start to work towards new targets or readjust and work through
existing choices.

We learned that
it is important to share information with key people when the re-evaluation
step is completed in the form of a summary of progress. The format of this
summary should follow that of other quality improvement projects in your
institution so that progress can be clearly demonstrated to accrediting
or licensing organizations, administration and management.